Patient Navigator (LPN) - HYBRID

Trinity Health•Boise, ID

20h•Hybrid

About The Position

The Health Alliance Clinical Team is hiring for an Nurse Patient Navigator to join their team. The Health Plan & Patient Navigator serves as a critical resource for colleagues and patients by providing care navigation and coordination services within Trinity Health’s Colleague Health Plan and Value-Based Care programs. This role ensures members and patients receive high-quality, cost-effective, and clinically appropriate care while reducing fragmentation, improving outcomes, and enhancing the overall experience. The Navigator collaborates with providers, health plans, care teams, and community resources to support population health objectives and value-based performance goals. The schedule is Monday - Friday 8-5. The position is primarily remote but may have some in-person meetings and trainings.

Requirements

Licensed Nurse in the state of Idaho (LPN) at the time of hire.
Bachelor’s degree in nursing, Human Resources, Healthcare, or related field OR equivalent experience.
3+ years in health plans, provider networks, or medical group practices.

Nice To Haves

5 years clinical experience preferred for licensed roles.

Responsibilities

Conduct timely outreach to patients following ED visits to ensure connection to appropriate in network, follow-up services.
Perform comprehensive chart reviews to identify medically necessary network direction and recommendation.
Coordinate and monitor referrals to specialists and community resources, ensuring timely appointments and closing referral loops to maintain continuity of care.
Collaborate with providers, insurance companies, utilization management, and care teams to align care delivery and value-based performance goals.
Serve as a knowledgeable resource for questions related to appropriate level of care, network utilization, member benefits, and evidence-based clinical guidelines.
Access insurance company portals for real time eligibility and member benefit summaries.
Facilitate review of providers out of network recommendation, assuring services are not available within the payer and or SAHA networks. This leads to either site of care redirect or payer approval or denial of out-of-net network services.
Maintain comprehensive knowledge of provider networks, care management resources, and community services.
Direct members/patients to appropriate providers, programs, and resources, including urgent care vs. emergency department education.
Assist in establishing primary care and specialty relationships; educate on network navigation and well-being programs.
Conduct outreach following ED visits to ensure timely follow-up and continuity of care.
Perform clinical chart reviews to identify medically necessary network direction and recommendations.
Coordinate and monitor referrals, ensuring timely appointments and closing referral loops.
Collaborate with providers, payers, and care teams to align care delivery with value-based goals.
Validate member eligibility and benefits; facilitate authorization processes as appropriate.
Identify trends in access or scheduling; report and recommend improvements using data and KPIs.
Provide education and feedback to providers on referral patterns and opportunities.
Participate in quality improvement initiatives, including data collection and evaluation.
Maintain compliance with HIPAA, regulatory requirements, and organizational policies.
Serve as an escalation point for member/patient access or care experience issues.